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Texas Department of Insurance
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BCBSTX consumer refunds and restitution

Blue Cross Blue Shield of Texas (BCBSTX) has agreed to pay restitution to consumers who paid balance bills for out-of-network emergency claims based on incorrect information in marketing materials. Consumers may be eligible for additional claims payments, reimbursements, or other restitution.

Who may be eligible?

Emergency claims: Current or former BCBSTX members in fully insured HMO plans, including Affordable Care Act plans, who:

  • Received out-of-network emergency care between August 1, 2017, and December 31, 2019.
  • And paid or have an unresolved balance bill for that care.

Marketing materials:  Current or former fully insured BCBSTX members enrolled in certain 2018 or 2019 plans who had higher out-of-pocket costs than expected based on information in plan documents provided by BCBSTX.

What happens next?

BCBSTX will send notices to members who may have been affected by these errors. The notices will go out in May and June. Once you get a notice, you will have 60 days to seek reimbursement from BCBSTX.

Can I get help now if I have an unresolved balance bill?

Yes. Call BCBSTX at the member phone number listed on the back of your ID card.

Former BCBSTX members who no longer have an ID card can call 972-766-6900.

What information will be needed to request repayment for a balance bill?

You’ll need proof that you paid the bill or have an outstanding bill for out-of-network emergency care received between August 1, 2017, and December 31, 2019. Proof of payment can be a credit card receipt or statement, canceled check, receipt from the medical provider, or a similar document.

For more information, contact: MediaRelations@tdi.texas.gov

Last updated: 3/6/2020